las

“To kill an error is as good a service as, and sometimes even better than, the establishing of a new truth or fact” ~ Charles Darwin (it's evolutionary baybeee!)

Thursday, May 24, 2012

The Misunderstood - or is it mischaracterized? - Pima

Alternate title: Battle Pima ~ Bernstein v. Taubes

In the comments on a recent post, Galina linked me to some online material by Diabetes "guru" Dr. Richard Bernstein. Anyone who's frequented low carb forums and blogs will recognize that name as probably the go-to authority on diabetes management with a low carb diet, and it's not too much of a stretch to state that he's the second-most cited authority behind the great Gary Taubes himself. Significant portions of his book, The Diabetes Solution, are free to read online, including his chapter on Weight Loss. He writes:

Before we discuss weight loss, it makes sense to consider obesity, because if you don’t understand why and how you are overweight or obese, it will be somewhat more difficult to reverse the condition.

THE THRIFTY GENOTYPE

When I see a very overweight person, I don’t think, “He ought to control his eating.” I think, “He has the thrifty genotype.” What is the thrifty genotype?

The hypothesis for the thrifty genotype was first proposed by the anthropologist James V. Neel in 1962 to explain the high incidence of obesity and type 2 diabetes among the Pima Indians of the southwestern United States. Evidence for a genetic determinant of obesity has increased over the years. Photographs of the Pimas from a century ago show a lean and wiry people. They did not know what obesity was and in fact had no word for it in their vocabulary. Their food supply diminished in the early part of the twentieth century, something that had occurred repeatedly throughout their history. Now, however, they weren’t faced with famine. The Bureau of Indian Affairs provided them with flour and corn, and an astonishing thing happened. These lean and wiry people developed an astronomical incidence of obesity—100 percent of adult Pima Indians today are grossly obese, with a staggering incidence of diabetes. Fully 65 percent of adults are type 2 diabetics. Since the publication of the first edition of this book, even many Pima children have become obese, type 2 diabetic teenagers. A similar scenario is now playing out across the United States in the general population. The pace may be slower, but the result is similar.

What happened to the Pimas? How did such apparently hardy and fit people become so grossly obese? Though their society was at least in part agrarian, they lived in the desert, where drought was frequent and harvests could easily fail. During periods of famine, those of their forebears whose bodies were not thrifty or capable of storing enough energy to survive without food died out. Those who survived were those who could survive long periods without food. How did they do it? Although it may be simplifying somewhat, the mechanism essentially works like this: Those who naturally craved carbohydrate and consumed it whenever it was available, even if they weren’t hungry, would have made more insulin and thereby stored more fat. Add to this the additional mechanism of the high insulin levels caused by inherited insulin resistance, and serum insulin levels would have become great enough to induce fat storage sufficient to enable them to live through famines. (See Figure 1-1.) Truly survival of the fittest— provided famines would continue.

So Bernstein endorses the Thrifty Gene hypothesis while Taubes argues against it (from GCBC):

The question of what causes obesity in these impoverished populations has typically been ignored by obesity researchers, other than to suggest that there is something unique about given groups of people that exacerbates the problem of obesity. The assumption, as The New Yorker writer Malcolm Gladwell wrote about the Pima in 1998, is that they are “different only in degree, not in kind.”

The idea of specific populations predisposed to obesity is encapsulated in a notion now known as the thrifty gene—technically, the thrifty-genotype hypothesis—that is now commonly invoked to explain the existence of the obesity epidemic and why we might all gain weight easily during periods of prosperity but have such difficulty losing it. The idea, initially proposed in 1962 by the University of Michigan geneticist James Neel, is that we are programmed by our genes to survive in the paleolithic hunter-gatherer era that encompassed the two million years of human evolution before the adoption of agriculture—a mode of life still lived by many isolated populations before extensive contact with Western societies. “Such genes would be advantageous under the conditions of unpredictably alternating feast and famine that characterized the traditional human lifestyle,” explained the UCLA anthropologist Jared Diamond in 2003, “but they would lead to obesity and diabetes in the modern world when the same individuals stop exercising, begin foraging for food only in supermarkets and consume three high-calorie meals day in, and day out.” In other words, the human body evolved to be what Kelly Brownell has called an “exquisitely efficient calorie conservation machine.” And so, by this hypothesis, we suck up calories when they are abundant and store them as fat until they are called upon in a time of need. “Your genes match nicely with a scarce food supply,” Brownell explains, “but not with modern living.” Such populations as the Pima and the descendants of African tribes, according to this logic, were until very recently still trapped in this cycle of feast and famine and scarce food in general, and so their thrifty genes have yet to evolve to deal with times of continual plenty. The NIH researchers who study the Pima, as Gladwell reported, “are trying to find these genes, on the theory that they may be the same genes that contribute to obesity in the rest of us.”

For the first few decades of its existence, this notion that we have evolved “thrifty mechanisms to defend energy stores during times of privation” was invariably referred to as a hypothesis. That qualification is now often dropped, but the thrifty gene remains only a hypothesis, and one that rests on many assumptions that seem unjustifiable.

James Neel initially proposed the idea of a “thrifty genotype rendered detrimental by progress” to explain why diabetes was so prevalent in Western societies and yet apparently absent in primitive tribes, including the Yanomamo of the Brazilian rain forest, who were then the subject of Neel’s research. Neel was addressing the diseases of civilization and the kind of observations that led Peter Cleave to propose his saccharine-disease hypothesis. (Neel was unaware of Cleave’s work at the time.) The enigma of Type 2 diabetes, Neel observed, is that it bestows significant evolutionary disadvantages upon anyone who has it. Diabetic women are more likely to die in childbirth and more likely to have stillbirths than healthy women; their children are more likely to be diabetic than those of healthy women. This implies that any genes that might predispose someone to become diabetic would evolve out of the population quickly, but this did not seem to have happened. One way to reconcile these observations is to imagine a scenario in which having a genetic predisposition to become diabetic is advantageous in some circumstances. (In a similar way, having the gene for sickle-cell anemia, normally a disadvantage, provides protection against malaria, a major advantage in malarial areas, as Neel himself reported.)

Since diabetic mothers are known to give birth to heavier children, Neel speculated that these diabetic genes bestowed an exceptional ability to use food efficiently, and thus an exceptional ability to convert calories into fat. Those with such thrifty genes, Neel explained, “might have, during a period of starvation, an extra pound of adipose reserve” that would keep them alive when those who failed to fatten easily would die of starvation. So it would be beneficial to have such genes in the event of famine or prolonged food deprivation, which Neel now assumed must have been the case throughout our evolutionary history. Those same genes would lead to obesity and diabetes in an environment in which food was plentiful.

“If the considerable frequency of the disease is of relatively long duration in the history of our species,” Neel had asked to begin his discussion, “how can this be accounted for in the face of the obvious and strong genetic selection against the condition? If, on the other hand, this frequency is a relatively recent phenomenon, what changes in the environment are responsible for the increase?”

The thrifty gene could be the answer only if diabetes was of long duration in the species—and there is no evidence of that. The disease seems to appear only after populations have access to sugar and other refined carbohydrates. In the Pima, diabetes appeared to be “a relatively recent phenomenon,” as Neel himself later noted. When Russell and Hrdli ka discussed the health of the Pima in the early 1900s, they made no mention of diabetes, even while noting the presence of such “rare” diseases as lupus, epilepsy, and elephantiasis.*71 As late as 1940, when Elliott Joslin reviewed the medical records of the hospitals and physicians in Arizona, he concluded that the prevalence of diabetes was no higher among the Pima and other local tribes than anywhere else in the United States. Only in the 1950s, in studies from the Bureau of Indian Affairs, was there compelling reason to believe that diabetes had become common. When Neel tested adolescent Yanomamo for the condition known as glucose intolerance, which might indicate a predisposition to diabetes, he found none, so had no reason to believe that diabetes existed before such isolated populations began eating Western foods. The same was true of an isolated tribe of Pima, discovered living in the Sierra Madre Mountains of northern Mexico. “The high frequency of [Type 2 diabetes] in reservation Amerindians,” Neel later explained, “must predominantly reflect lifestyle changes.”

By 1982, Neel had come to side with Peter Cleave in believing that the most likely explanation for the high rates of obesity and diabetes in populations like the Pima that had only recently become Westernized was their opportunity to “overindulge in high sugar content foods.”

So there you have it. Were I to excerpt everything Taubes says about the thrifty gene, I'd probably run afoul of fair use law. You can see a summary by Gatewing here. Two "authorities", two different takes on the Thrifty Gene. It is instructive to recognize that Taubes bases a significant portion of his remaining TWICHOO on another Neel hypothesis as to the etiology of insulin resistance, and how IR causes obesity. This is equally flawed vs. previous versions of his hypothesis, but the current working version whereby fructose is the real culprit. I'll be addressing this soon. Yep. Taubes again. ;-)

In any case, Bernstein evokes the Pima as a model of famine induced genetic selection towards being more obesity prone. While genetics doesn't seem to explain things, epigenetics does. I apologize for not referencing this part, but there is a plethora of peer review literature on two phenomena that tend to explain the paradoxes we're told CICO does not. There are some other explanations, but here's one. Low birthweight for gestational age (and premature) babies are at high risk for obesity and diabetes later in life. A period of famine would result in higher proportions of such babies born, and 20-30 years later, we see obesity and diabetes provided the famine has subsided. If you do a Google Scholar search on famine and obesity or diabetes, the literature is full of this. Even if born normal weight, malnutrition in childhood results in less weight gain, but the proportion of that weight that is squirreled away fat is far higher. We see this in CR studies conducted from birth -- the metabolic rate is downregulated and the organism becomes more efficient. When the individual is adequately nourished later in life, they will more likely be in caloric surplus (due to suppressed metabolic rate) and be more likely to partition that surplus to adipose tissue.

Back to Battle Pima! At right is a slide most will be familiar with from innumerable lectures. Hey! I just caught another inconsistency in GCBC ... say it ain't so!!! Check out the graphic: Fat Louisa is from 1901-1902!!!!!! And yet I repeat from above:

When Russell and Hrdlika discussed the health of the Pima in the early 1900s, they made no mention of diabetes.

Now Louisa is just the poster woman for obesity, but since we're talking thrifty genes and all that, not to mention Neel's {paraphrase} "anything that raises insulin causes insulin resistance" hypothesis, this crack in the timeline is pretty substantial here. So nevermind that Bernstein is sunk by the prosperity of the Pima in the mid 1800's, Gary's pretty sunk using Louisa (who perhaps was the Pima equivalent of the Fat Lady at the circus rather than representative of the population?!).

But what do Taubes and Bernstein share in common? An ignorance of facts I would contend. It's not like the literature is not full of studies on the Pima. One that I've cited repeatedly is Boyce & Swinburn's 1993 analysis of the Pima diet circa turn of the 20th century: "although seasonably variable, was ∼ 70–80% carbohydrate, 8–12% fat, and 12–18% protein" . Another study (Ravussin et.al.) compared the Arizona Pima to Mexican Pima in 1994.

The Pima diet consumed at the time of the study (October) appeared very monotonous and lacked several essential nutrients because of the relative absence of fruits and vegetables. The main staples were beans (Phaseolus Vulgaris in four varieties), corn as tortillas, and potatoes. Preliminary data by semiquantitative food frequency and 24-h recall suggests that ~23% of total energy intake is derived from fat. This amount seems to be slightly higher than that reported in the diet of the Tarahumara Indians (41) but much lower than that in the present Arizona Pima diet (32). The main sources of protein and carbohydrate in the diet were corn tortillas, wheat flour tortillas (which include ~30% vegetable fat in their formulation), and beans, which are typically fried with variable amounts of vegetable oil or shortening (Table 2). Other important energy sources were inexpensive pasta soups and potatoes, which are cultivated in the region or sold by traveling vendors. The consumption of animal products, such as meat and poultry, was rare, and, in most cases, these items were consumed only once every month or two. However, eggs and powdered milk were more frequently used, depending on the availability of cash to purchase such items. Dietary fiber intake was probably high (>50 g) because of the substantial consumption of beans and tortillas.

Sorry, but this sorta puts the whole low fat and even NAD angle seriously in question, wouldn't you say? Veggie oils, grains, legumes and a relative absence of animal fats and proteins in Mexico with substantially lower incidence of obesity and diabetes. At 23% fat, modern Mexican Pima are consuming more than Arizona Pima circa 1900. Is carbohydrate causing the problems for the Pima we see today? I don't see how anyone can make that claim with a straight face. The conflicting use of the Pima by Taubes and Bernstein brings the credibility of both into question.

Another magnificent post, Evelyn. Leaving out the fact that an entire generation had elapsed between the original starvation generation, and the fat one that followed it, is the very definition of fraudulence, and distortion.

Epigenetics also may explain the incidence of obesity in the generaiton of Dutch born after the "hunger winter" of 1944-1945.

Two different human populations, two different genomes, same result.

http://www.nejm.org/doi/pdf/10.1056/NEJM197608122950701

http://www.news.leiden.edu/news/dutch-hunger-winter.html

I can only imagine how FRUSTRATING it must be fore real scientists to read this crud and say, "but wait a minute! That's just not so!!"

One thing I've never gotten about believing Taubes, is that he offers an ALTERNATIVE that even comes any where near explaining these phenomena any better! Why are not the kids weaned on carbs getting fatty fat fat ... why is it later in life? If it's all about the insulin, that is.

Another great blog post that makes me want to kick myself for not having as discerning an eye as yourself when I first read Taubes. The good thing I have learned from my whole LC/Paleo experience is the ingraining of caution and being critical of what I read before jumping off the deep end. Normally I am, but like I have mentioned before I was coming off an emotional health issue and emotion was more in control than my pessimistic brain. I needed help and Gary came along with his snake oils.

One thing I have decided is to seek out advice and ask questions to people who have more knowledge in the field of exercise/nutrition beforehand. More minds working together is the best way to combat bullsh*t!

If the Pima suffered famines throughout their history (assuming that is factually correct quoted from Bernstein), I fail to see why a famine preceding their obesity epidemic means anything. If famines are known to the Pima, and never before resulted in an explosion of diabesity, this suggests the Pima's obesity is not a result of famine, but rather explicitly a result of the food they are now eating AFTER the famine , as this is the only thing that changed between the time before and after the development of obesity.

I agree the Pima are not an argument for low carb diets, they are merely an argument for the geneticness and innateness of obesity proneness when consuming western agricultural diets. While this isn't politically correct in a delusional world where we pretend there are no biological differences between ethnic groups (even though there clearly are, e.g. asians cannot metabolize alcohol for example)...It is not a coincidence that most fat people are brown / black. I would not be prone to obesity if my grandmother wasn't an african transplant, this is the only family member who has metabolic disorder and obesity. If not for this singular difference (1 of 4 grandparents was a direct first generation descendant of an african tribe) I would be an obesity resistant obnoxious caucasian spouting off about the sedentary and overeating poor classes who are hypersensitive to food reward, who just can't get the education and willpower to be naturally thin like myself. Unfortunately the contribution of grandma's genes means I know what it is like to have acanthosis nigricans and severe obesity on a normal diet and I was never afforded that delusional privilege.

Obesity does occur sometimes in non-hunter gatherer people but it is clearly far more common in people who do have hunter-gatherer-nomadic heritage. I tend to think the massive obesity in america (compared to europe) particularly in the southern parts of america, is not a result of "southern cooking" but a result of the fact most southerners are heavily mixed with native americans and other tribal people. They have quite a large amount of these genes predisposing them to diabetes and obesity, even those citizens who may identify as caucasian.

When one reads up on the native Pima diet, it is loaded with non-digestible bulk. Unrefined grains and plant food that yields very few digested calories. The Pima may have selected for genetics that exquisitely extract nutrients from ingested food, which of course now leads to crazy obesity and diabetes when fed a western agricultural diet which is more refined with more bioavailable nutrition from starch and fat. If your previous diet is like ground up roughly processed corn and gritty seeds with almost no bioavailable calories, and this diet was producing healthy body weight... dont' be surprised when the diet shifts to tons of liquid fat and flour that you see an explosion of obesity and diabetes in people otherwise adapted to the nut and seed and grass diet.

Either way, famine is not the reason the Pima have obesity as your own admission states Pima had famines throughout their history, so I fail to see how this would be relevant to the massive obvious change in their health after beginning western diets.

Your arguments are countered easily by pointing out that insulin resistance typically (traditionally anyway) occurs later in life. It is insulin resistance that leads to hyperinsulinism when eating mixed meals and carbohydrate.

Children do not become hyperinsulinemic eating carbohydrate, however some adults do, and then begin to gain weight (first) which may progress to diabetes (later) if insulin secreting capacity becomes exhausted or insulin resistance becomes truly severe.

This is also why children who are thin and wirey with healthy metabolisms run around after eating sugar: they are obesity resistant and the sugar leads to a hypermetabolic state with increased energy. You don't see fat children running around after ingesting sugar. It's not because they are defective or lazy, it's because their body is not producing energy in response to food like the thin sugar fiend kids.

Today, metabolic disease is so extensive for a variety of factors, it is actually true that infants are fatter, children are often obese, and so are teenagers. Obesity and diabetes are no longer associated with age.

You are confusing "carbs" with "hyperinsulinism" as if they were absolutely linked and one naturally follows the other. If Stephan Guyenet eats a potato, he does not overproduce insulin, he does not get hypoglycemia at 1.5 hours, leading to enhanced hunger and eating because excessive blood insulin is directing nutrition to storage leading to a decline in blood nutrients and greater feeding. If he does this every day he will not gain weight, or develop acanthosis nigricans, an unmistakable symptom of chronic hyperinsulinemia, ubiquitous in insulin resistant or hyperinsulinemic and most obese people.

My brother grew up in the same family as I did ate the same food but is genetically insulin sensitive, normally uses glucose, regulates insulin appropriately. He never becomes hungry 1.5 hrs after meals. He only experiences hypoglycemia if he does not eat for a super long time, he never experiences it after normal food intake even if he eats a big plate of pasta. His body weight stays exactly the same in the normal range. When I describe how (carbohydrate) food makes me feel in terms of energy and appetite he cannot even slightly relate. Conversely, I can only relate to how he feels when I eat a high fat ketogenic diet free of substantial carbohydrate. Then I too do not get hungry 1.5 hrs after meals, and I too easily burn body fat after meals, and I too do not endlessly accumulate body fat and am thin.

Carbs will only produce abnormal hyperinsulinemia in people who otherwise are glucose intolerant.

It would be nice if we stopped default assuming the only difference between fat people and thin people is that fat people are weak and gluttonous and are overconsuming nutrition and laying on their fat lazy asses. Over eating and laziness is a result of metabolic/endocrine/nervous system abnormality and obesity is another symptom as well. It seems you are suggesting it is some kind of mental/emotional thought process unique to corrupted evil adults, which is absent in the pure children who eat to hunger and never gain weight. Reality time: I was a fatass as a child, and so are many if not most obese people. People who gain weight later in life typcially only slightly gain weight, associated with the failure of their metabolism to normally process glucose and resulting excessive insulin responses to carbohydrate, which they otherwise neverexperienced in their early 20s teens and childhood years.

Woo, I'm familiar with some of your personal story but not your overall opinion on obesity in general. I am curious as to what percentage of modern obesity you believe is caused by poor glucose tolerance and reactive hypoglycaemia due to genetics or metabolic/endocrine/nervous system abnormality and how much by other factors?

I can't estimate a percentage. I don't think it is totally genetics or totally "other factors", I always think it is a combination, almost every case is a combination of genetics plus environment...however, the genetics MUST BE PRESENT, you can't develop these issues if the genetic vulnerability is not there. This is evidenced enough by all the thin people guzzling soda and sitting on their asses who are weight gain resistant and never develop any signs of metabolic disorder .

So if your question boils down to "what percentage of obesity is influenced by genetics" my answer is 100%.

On my blog I have (in a mocking, sarcastic tone) extensively voiced my opinion of the stupid FR hypothesis and how it has no relationship at all to my experiences as an obese person or even makes rational sense, or is consistently stated. Stating my opinion / conflicts with conventional view of obesity and FR hypothesis requires at least 2 blog posts, which would just be abject spam... so I posted my reply on my own blog for anyone who wishes to read it:

Woodey, don't kick yourself too hard. I had read/heard a lot of Taubes obesity stuff before I relented and read the book. When you read it "out of context" as I did first, it doesn't make sense. He is a talented writer in that he weaves a tale that sucks you in. I've heard many people say something to the effect that they were so mad after the first part on fat and cholesterol they just ate up the obesity part. He's also a genius at stating an unassailable fact then slipping in -- unreferenced -- his twist. I'm surprised the Pima fable has persisted, however, as it is so easily shown to be false, and he even trips over the delivery in lectures. The words wheat and corn and such do not pass his lips easily, but they're part of the lecture. ;-) I tend to think if one looked more closely into the litany of other cultures he provides, explanations can be found. He uses the Pima to counter the prosperity/abundance theories of obesity, but it shoots TWICHOO in the foot!

. The observations that maternal vitamin D insufficiency might be associated with reduced size at birth, but accelerated gain in body fat during early childhood,

I hope to get back to my fat accumulation series as there is quite a bit there wrt low birth weight babies. I'm going to have to look for the actual study. I wonder if they determined mother's weight (they said weight gain in pregnancy didn't explain it, but no mention of weight in general). A while back I was looking quite a bit into VitD. There definitely seems to be a degree of adiposity over which VitD is sequestered away in fat = low D status.

Sounds like reasonable VitD supplementation during pregnancy would be a good idea!

We don't know whether or not famines in the past precipitated diabetes/obesity. It seems plausible given the numerous figurines in various cultures of corpulent men and women, even in the stone age.

"I tend to think the massive obesity in america (compared to europe) particularly in the southern parts of america, is not a result of "southern cooking" but a result of the fact most southerners are heavily mixed with native americans and other tribal people."

There is absolutely no evidence of this that I know of and in fact most Southern families who profess a Native American ancestor (such as my family) turn out to have no such thing upon analysis. Even with 100% caucasian genes, morbid obesity is rather common in my family. It would not surprise me if a factor in obesity is not human genetics, but bacterial genetics.

That said, there really are genetic differences at play here. I have been meaning to write a post on the experiences of the Inuit vs. the Pima vs. Siberians vs. Australian Aborigines. The health problems of those four communities are quite different.

"When one reads up on the native Pima diet, it is loaded with non-digestible bulk. Unrefined grains and plant food that yields very few digested calories. "

I'm not sure this is true. Many indigenous cultures have been producing extremely refined starches for a long time. I would have to read more about the processing that the Pima used, but Australian Aborigines and New Guinea Highlanders even in the Paleolithic were producing very fine flours with enough refined carbohydrate that they were cariogenic, which possibly has to do with the selection for salivary amylase copy variation. A lot of South American tribes also make chicha, which is a highly refined (using saliva sometimes!) alcoholic corn drink. I have ground my own masa from raw corn using just stones and it produces a pretty delicious tortilla. Add nixtamalization, which the Pima knew about, and it's not exactly Grape Nuts.

"It would be nice if we stopped default assuming the only difference between fat people and thin people is that fat people are weak and gluttonous and are overconsuming nutrition and laying on their fat lazy asses."

I don't see how it's possible to have rational discourse on this subject when you are interpreting things this emotionally. Overconsumption is usually not a conscious activity. Chronic binge eaters like me are exceptions. But even there, it's pretty ridiculous to put any moral weight onto what is essentially a mental disorder. It's like blaming alcoholics for not being able to hold their drinks or people with severe depression for not trying to be more cheerful.

"I would be an obesity resistant obnoxious caucasian spouting off about the sedentary and overeating poor classes who are hypersensitive to food reward, who just can't get the education and willpower to be naturally thin like myself. Unfortunately the contribution of grandma's genes means I know what it is like to have acanthosis nigricans and severe obesity on a normal diet and I was never afforded that delusional privilege."

So presumably when you refer to a "normal" diet you mean a 70% + whole food high carb/super high fiber diet with fat intakes somewhere in the neighborhood of 8% right? You know...a diet similar to what the pima and probably your ancestors were eating while in their non obese native environment? You became obese on THAT diet or you became obese on a high fat high refined carb diet with lots of engineered foods that everyone else becomes fat on although you did it faster and to a greater extreme like other people whose genes give them less adaptive protection?

"Obesity does occur sometimes in non-hunter gatherer people but it is clearly far more common in people who do have hunter-gatherer-nomadic heritage. I tend to think the massive obesity in america (compared to europe) particularly in the southern parts of america, is not a result of "southern cooking" but a result of the fact most southerners are heavily mixed with native americans and other tribal people. They have quite a large amount of these genes predisposing them to diabetes and obesity, even those citizens who may identify as caucasian."

Agreed except I think it's probably both. Fried breads are pretty common in both "southern" cooking and current native american obese populations. Lots of sugar, lots of fat, very little fiber are characteristic of both diets.

I have always been able to become hyperglycemic to a greater degree than my peers ESPECIALLY in high school when we spent a few years in the Midwest while my mom did a couple of grad degrees. I learned fast that a few slices of pizza and a couple of cokes could give me the nauseated shakes for hours and bring my merry making to an immediate and total halt.

So in that sense...I am in complete agreement with you. However, despite it's availability [we had coke machines in the caf in high school] the only time I could ingest enough soda at one sitting to GET that effect was if I was consuming it with fat...or more correctly high reward high fat food. I have no idea if JUST fat all by itself would do it because I never sat down with a coke and a stick of butter just to see what would happen. A coke consumed by itself...1/3 the way through the first can and I was done.

Now granted I was raised on a low fat semi vegetarian diet. We ate meat only a few times a month not for any philosophical preference but because my mother was busy and meat prep/clean up was not high on her list of priorities. Almost all of our food at home was whole rather unrefined food again for the purposes of practicality.

If I was going to get fat or sick merely from exposure to carbohydrates I certainly had my opportunity but in fact I was extremely lean like the rest of my family. My weight and ability to ingest adequate sugar on a regular basis to give me symptoms of insulin resistance both went up when I married a man whose entire family were chronic SAD high reward eaters [and unsurprisingly also had strong familial histories of both addiction and depressive type disorders]. Ironically his family is also as white bread as you can get without being visible from space. They do not tend toward obesity despite their high SAD type intakes. I gained weight to a greater degree and FASTER on their diet. When I returned to my previous way of eating/living my problems went away and stayed away despite pregnancy and other lifestyle compromises.

My experience is a pretty good anecdote of an individual with the ethnic genes of two obese populations [Irish/Native American] who also happened to be predictably lean and healthy on the diet/high activity lifestyle that accompanied the lean and healthy history of both populations and who got fat and sick under the same relative environmental conditions as others with similar ethnic backgrounds.

I agree with a lot of your observations but the conclusions? Not so much.

For clarification when I say "Irish" I mean recent immigrant..as in...was present during the potato famine rather than "Irish" waaaay in the distant past. The reason I included Irish with Native American was because both populations were a conquered people who endured long term subhuman status and had to rely on gov't rations after spending a lot of time on a very high carb diet who both get very fat and very sick quickly on a SAD type diet.

When you said you found my link useful, you meant it. Do you really think using wrong theory explaining Pima's situation should affect Dr.B. credibility in a big way? No one is right 100% all the time. The thrifty gene was mentioned all over the places a while ago, I remember,for example, reading about it in an old "Protein Power" book .

There are many groups of people who experience decline in their health after abandoning traditional diets for Western sugar and refine wheat. "The nutrition and Physical degeneration" http://gutenberg.net.au/ebooks02/0200251h.html(another free-on-line book) comes to mind in such case and is a good illustration to the variety of possibly healthy diets.

Some people and groups of People indeed are worse off on a Western diet then others. I think just macro-composition a of diet doesn't provide the whole picture. Many traditional groups used to eat in a pattern that is like IF. Another anecdotal evidence I know you don't like much. One of my friends in Moscow didn't change anything in her diet, besides eating times - first meal at 11 am (usually oatmeal, a rice- or a buckwheat gruel, black coffee), second at 5 pm, nothing at between but green tea without a sugar, her food is heavy in carbs, she likes ice-cream and deserts. She is not prone to obesity, small-framed, even fragile, but after 45 had to to control her middle-section spread. She doesn't understand why I have to be streaker with my diet. Without carbohydrates she doesn't feel she ate enough even after a protein-heavy meal.

I can relate to the emotional reaction on the CICO advice, and I can sign under the phrase

"It would be nice if we stopped default assuming the only difference between fat people and thin people is that fat people are weak and gluttonous and are overconsuming nutrition and laying on their fat lazy asses."

Many people who surround us assume exactly than, what people with extra weight either eat too much or don't move. It hearts A LOT.I diligently followed ELEM advice most of my adult life with the result of slowly but steadily growing weight and accumulated sport injuries. Only after I drastically reduced carb-content of my food I managed to be in a control of my weight. I still feel pretty much pissed-off as a result of my experience, but I am less gifted than Wooo in my ability to put it all in writing. When I think how I have been accused silently or not of being lazy ass for years , it makes my hart pounds. I felt justified first time in my life after I learned about LC theory and tried it on myself.

It is possible to participate rationally in discussion if present rational facts.

It is not possible if you see facts and your brain puts a personal rinse on it that says "What you really mean is ..."

" ...the only difference between fat people and thin people is that fat people are weak and gluttonous and are overconsuming nutrition and laying on their fat lazy asses."

Having been on both sides of the line I can easily recognize the feeling of injustice when criticized by people whose bodies are functioning sufficiently to allow them to react/respond to stimulus in their own self interest [which would be considered admirable socially] however the facts presented as facts are not a moral judgement.

I have discovered that I have a narrow environmental window for success if I want to look and feel my best...for me personally it doesn't involve replacing carbs with fats although several people in my husbands family DID do well by all measures using old school Atkins. I get really sick from that and experience the same mood alterations/low energy/insulin resistance symptoms [including acanthosis nigricans] other people describe from eating SAD. My husband gets really depressed and lethargic from eating low fat. IRL this means he puts butter on his broccoli and I put beans on mine and we are both happy.

A close friend of mine has one daughter who is predisposed to obesity. She does seem very lethargic and gluttonous to the casual observer and her situation is a complete mystery to her tiny never overweight at any point bulletproof to all mood disorders mother. She is also obviously depression prone. Surprise surprise on both sides of her family both ADHD/depression type diagnosis AND addiction is very prevalent. Especially in her husbands side...and yes he certainly can gain weight with no trouble when she isn't managing his diet for him. I would not want to be this girl under any circumstances but especially not as the daughter of my beautiful, industrious, and much admired mother.

I do think that there is something full body biological and for sure neurological going on that is completely legit however I really think limiting the observation to a single variable involving fuel partitioning is a mistake.

You asked "why are children weaned on carbs not experiencing hyperinsulinism". The implication is the insulin hypothesis of obesity would state all carb eating leads to hyperinsulinemia, so this observation is evidence against it. Carbs do not equal hyperinsulinemia unless one also has a metabolic disorder similar to type II diabetes. Most children do not develop this disorder until later years...although in modern times we are seeing metabolic disease occurring earlier and earlier probably because of the progressive effect of interuterine programming (children swimming in wombs of glucose, insulin, cortisol and leptin) and progressive nutrient depletion.

@PDaddy Actually the statistics demonstrate obesity and diabetes are more severe and commoner in certain ethnic groups with recent hunter gatherer heritage. You probably only think your community is equally fat because you are not exposed to other people who are actually fatter.

@Bentley

WHen I said "normal diet", I was referring to "the normal food everyone eats and does not develop acanthosis nigrcans, massive progressive obesity, and chronic hypoglycemia after meals".

I meant "normal" in the context of the diet I now eat to sympatomatically control this disorder, a diet which is restricted of carbohydrate, supplemented with numerous glucose tolernace enhancing nutrients, and meal timing/size is also controlled to maximize insulin control.

Most people, almost all people, can eat a "normalish" diet (i.e. the foods around us) and avoid the severe early onset complications I developed in my childhood and teen years. I believe my genetics (african tribe, hi!) as well as other factors (progressive interuterine programming for metabolic disease...nutritional depletion...etc) are the reason I have no choice but to eat the diet I now eat or else. I do not htink my ancestors were eating my sort of diet, the diet I now eat is a therapeutic diet because my body is FUBAR. Obesity is a disease and it will require therapy to control, it will not be as simple as "JUST RETURN TO YOUR NATIVE DIETZ" or eating a bland potato.

Hyperglycemia is always worse with mixed meals (carb + fat) and it isn't the "reward value". Here Bentlyj74 you are demonstrating my point ( #3) against FR : people offering evidence for food reward are ignorant of the real mechanisms they observe what they do.

One reason for this is low dopaminergic tone, which leads to inappropriate chronic fat oxidation even when carbohydrate is present. Adding fat to a carb meal will result in hyperinsulinemia and rapid weight gain and hyperglycemia in this case.

Not reward, just physiology. A lack of dopamine sensitivity will occur in all thrifty metabolic states. A lack of dopamine binding occurs in all energy conservation states.

I would not be surprised if the diet you were exposed to as a fetus and child has permanently altered your metabolism to diabetes and obesity... deprivation diets can do this just as well as obesity/diabetes of the mother. Or, it might be simply an effect of your NA genetics.

I know what it ISNT: reward value of diet because that doesn't exist. By your own admission your husband has a caucasian family that resists obesity / diabetes in spite of piling back these so called "rewarding" foods.

I think I misunderstood your original post, I thought you were saying you were ethnically irish and NA but it seems as if you are saying you are 100% irish.

The rates of obesity in irish people are nowhere near native americans and other hunter-gatherer people exposed to modern diets. Your point about stress and deprivation is true but there is clearly a distinct, immutable genetic contribution to the sorts of things that happen to Pima tribes or others with hunter gatherer ethnic heritage.

Yes, I observed a lot of injustice. One of my lady-friends has PSOS, has to shop in a big size stores and clearly despised by her small-framed elegant and slim beautiful mother (she is still beautiful in her early 70). The mother has DT2(well controlled), grandma who was very overweight had it too. As far as I know, my lady friend so far has PSOS alone, but she is around 50.Sure, not every diet approach fits everyone, and there is no guru out there to tell me or you what to eat in order to get more close to our goals or to feel better, it is to be figured out individually. During my LC experience it was easy to notice how much macro-nutrient content of my diet affects my mood in a very positive way.("Your brain on ketones" by Emily Dean speaks to me) However, reading other people comments I noticed that many couldn't go too low in carbs without feeling jittery and having troubles with falling asleep. It clearly indicates that for many people it is reasonable to look into their macro-nutrients in order to optimize their moods because what they eat changes how they feel . I am not declaring I know the answer for everyone, but a lot in how somebody feels depends on the stability of his/her blood sugar levels, and details of one's diet and eating regiment affect it a lot. Declarations like Dr.Oz said about Oprah that she couldn't loose weight because she didn't feel loved enough are total BS for me. I recently heard another gem - one lady told about her aunt that she couldn't exercise due to excessive weight and several amputated toes(DT2), but since she needed her opioid receptors stimulated somehow, she had to eat grains and sugar.Probably right now I am making upset somebody with a binging disorder or anorexia, I am sorry if I do. I want to tell again that there are a lot of people like me who should control their carbs to a different degree in their diet on a first place, and it often takes care of their other issues and problems. I realize it is not true for everyone.

He uses a lot of emotional manipulation describing experiences and symptoms that people identify with so it's easy to conclude "Hey! This guy knows what he's/I'm talking about." Unless you actually know what the stats are in regard to say...the Pima [because every person spends their spare time researching the history and dietary habits of obscure native populations, right?]... before you read his material you won't know that his claims are not supported by his evidence and a lot of stuff just flies under the radar.

The reason I highlighted the use of the term "normal" is because it is so relative. What you call normal may not look normal to me at all and vice versa. My point re the native diet was that it is just as likely if not moreso if there is anything to the native genetic angle that it's your European fat adapted genes which enable you to do well on a high fat diet. Your African ancestors were almost certainly not eating a high fat diet and they do remarkably poorly with remarkable speed when they are exposed to them.

Same with mine except in both cases I lack the fat adapted genes as both populations were extremely high carb and both populations predictably gain weight and get sick when their fat percentage goes up and their carbs go down. It might all be bullsh*t but if I were going to speculate my theory is at least as viable as yours.

I don't see any evidence for consideration of my familial diet as a diet of deprivation [more emotion on your part?] as it reliably produced lean, healthy individuals who are long lived and successful eating it for many generations.

The question isn't insulin OR food reward and framing every discussion that way just means you tread water.

@Wooo, of course the genome can influence tendencies. So can epigenetics. But that doesn't begin to explain why there was only one "fleshy" lady in our village when I was a kid (mid-20th century) and now they are everywhere. It also doesn't explain why the doctor who delivered my mother didn't ever see a heart attack. (I may err on that last point, my memory not being what it used to be.)

"Hyperglycemia is always worse with mixed meals (carb + fat) and it isn't the "reward value"."

Right, hyperglycemia is worse with mixed meals...but you missed my point. Without the "high reward" food I would never have consumed enough of it to become hyperglycemic in the first place because I am/was naturally insulin sensitive. Soda tastes like battery acid to me beyond the first 1/3 of the can. Drink it on top of 1200 cals or so of pizza at a party and it's down the hatch before I even noticed until I get good and sick.

"Here Bentlyj74 you are demonstrating my point ( #3) against FR : people offering evidence for food reward are ignorant of the real mechanisms they observe what they do."

Your level of education re biology does not exceed mine and neither one of us is comprehending sophisticated neurobiology at Stephen Guyenets level. It is foolish and ridiculous to imply otherwise. You are undone by your own argument.

Ditto ProudDaddy's comment. After all, I'm sure the plump bourgeois Han Chinese have more African blood than the peasants who have to make do with rice gruel. And of course, they acquire more African blood by the process of hopping a plane and settling in the UK or US, as demonstrated by increasing adiposity after arrival.

"I know what it ISNT: reward value of diet because that doesn't exist. By your own admission your husband has a caucasian family that resists obesity / diabetes in spite of piling back these so called "rewarding" foods."

European Caucasians are well known to be better adapted. This isn't a newsflash. Higher doesn't mean immune, but yes...higher tolerance.

Overall...their health is poor. Their executive function is relatively poor. Both parents had complete sets of false teeth before 60. They have a lot of addiction/depressive type issues in the extended family. His mother died quite young [early 60's]of an aneurism and was debilitated and sick before then. She wasn't obese though. I on the other hand got fat lickety split...I'm talking increasing my fat percentages by double if not more in a really short time eating the same diet that they just sort of hover at. Some of them do get fat..er. But not really as fat as you'd expect considering so yeah...I do think there's something to adaptation/predisposition.

ItsTheWooo wrote..."Children do not become hyperinsulinemic eating carbohydrate..."You left out the word "Most" at the beginning of that sentence (you included it in your later post). I used to fall asleep after eating a plate of chips when I was 8. Until I went low-carb at the age of 42, I always used to feel sleepy after eating bread, pasta or potatoes.

Now that I have corrected my insulin sensitivity, I no longer feel sleepy after eating bread, pasta or potatoes.

Most was implied.My earliest memories as a child involved crying and being anxious a few hrs after breakfast, impulsively demanding food. All adults found it amusing that the fat butterball child cried for food like this. I didn't understand why this happened to me until 20 years old when I found low carb dieting and learned this was called hypoglycemia.

good luck to you bentley & Nigel ... Maybe I'll get the taste for it again but I'm completely tired of it for now; trying to exchange useful information with people who can't be bothered to even understand something before they try (in vain) to debunk it.

What's the logic, exactly? "I read a few lines, I disagreed, now I'll hen make up all the cr*p in the world arguing against something I never understood in the first place".

phphphphphphphtttttt.

Too bad I have to manually skip over some commenters. When, oh when will Google add the "ignore commenter" feature to the blogs & the google reader?

I never suffered from anxiety after eating or drinking lots of carbohydrate. It looks as though your blood glucose level fell to well below normal some time after eating carbs. Mine didn't.

I got a lot of pleasure from eating sugary French Fancies & drinking sugary Corona Lemonade & eating chips (French Fries to you) and I never felt ill after consumption, just sleepy. That's why I believe in Food Reward and why I believe that my experiences are much more like those of the general population than yours.

Woo said: "You asked "why are children weaned on carbs not experiencing hyperinsulinism". The implication is the insulin hypothesis of obesity would state all carb eating leads to hyperinsulinemia, so this observation is evidence against it."

We don't know whether or not famines in the past precipitated diabetes/obesity. It seems plausible given the numerous figurines in various cultures of corpulent men and women, even in the stone age.

When I was looking into this a while back there does seem to be quite a bit of evidence for this. However since the obesity tends to manifest in adulthood, and diabetes usually later in adulthood, it seems unlikely this altered genetic selection. Further it seems contradictory that a propensity towards an unhealthy metabolic state would enhance survival.

I have been meaning to write a post on the experiences of the Inuit vs. the Pima vs. Siberians vs. Australian Aborigines. The health problems of those four communities are quite different.

Looking forward to this!

Wooo: "It would be nice if we stopped default assuming the only difference between fat people and thin people is that fat people are weak and gluttonous and are overconsuming nutrition and laying on their fat lazy asses."

I don't see how it's possible to have rational discourse on this subject when you are interpreting things this emotionally.

Agree three, or is that four? Wooo, I do find this odd coming from you. You did write the following once on your blog, right?

"Within a minute of my car appearing in front of this school, a bunch of bored fat housewives stood in front of my car and refused to let me drive for about 15 minutes because one of their precious little crotch dropplings may get run down. They yelled and threatened to call the police if I so much as moved 5 miles per hour. There is no law a person can't drive in front of a fucking school. You can't drive if a school bus is stopped (obviously, it means children will be getting off the bus and this is not a stable situation to drive).

I got out of my car, yelled at these women: INSTEAD OF HARASSING A MEDICAL WORKER on my way to bust my ass for the next several hours to take care of the elderly and infirm, meanwhile you fat useless slobs lay on your asses watching dancing with the stars shoveling back pizza and soda...why don't you teach these little out of control children not to walk in the street in the first place? "

It seems to me that genetics cannot explain this epidemic. You are young and grew up in the environment that fosters it. Us ancient types remember a time when the environment was different and there was only one or two "fat kids" in a class.

Hi Galina, No, if this is an isolated error, it's not catastrophic. It does seem he's in the carbs -> IR camp which makes me wary, but I've not read enough by him (as opposed to what others say about him) to say much either way.

As to "Some people and groups of People indeed are worse off on a Western diet then others. I think just macro-composition a of diet doesn't provide the whole picture." I agree totally, which is why I think the idea that carbs make you fat is so ridiculous.

I don't know why everyone who got fat did. I am also sort of puzzled why not everyone in Jemmy Moore's situation in such environment we are now. It looks like people are different. According to what I saw early in my life , absence of a junk or manufactured food doesn't guarantee the 100% thin population without diabetes, high blood pressure and other norms of our society, but you will not get fat children and youngsters. I was not a fat child, but slightly chubby, often wanted to eat, was less active than other children, spent a lot of time reading and doing my paintings, later in live knitting and sewing(it was the only opportunity to loot stylish in a socialistic society).I was involved in sports and walked often, but liked to sit more than other children.

I am mostly interested in what to do for individuals who got fat while eating like everybody else around them. Something makes some child always hungry, usually it is a sedentary child, but not always. At that point we can't change anything in a prenatal history, we now dealing with what happened already. I am glad you put that famous picture of fat Luisa in your blog post next to the evidence that she most likely was a freak occurrence in a healthy population. Why SHE became fat? Probably, the percentage of consumed carbs is not important for the whole population eating any traditional diet, after substantial adaptation time any healthy group of people figured out how to thrive on what was available for them. Thriving population does not mean the total absence of fat females. Inuits women were overweight according to the recollection of travelers. I don't want to mention the insulin theory of obesity. I didn't measure my insulin levels any time. However, minimizing the amount of carbohydrates in my diet allowed me to eat to the pattern of people who are not prone to the obesity and freed me from the constant hunger. Now , like my naturally thin lady-friend, I can have only two meals a day, or fast if I choose to do so, or eat less. For me it looks like I get a better assess to my fat storage, but it is a speculation on my part. Missed meal will not cause me a migraine or an unbearable hunger. There are a lot of evidence that IF pattern of eating compensates a lot of diet sins. It also looks like the over-eating on any food is unhealthy. My guess that Inuits women could get fat because they spent all day inside with opportunity to snack when they felt like it. As a person who lived in a cold climate, I can tell, you feel better when you eat.

I absolutely love your blog.. Pleasant colors & theme.Did you develop this website yourself? Please reply back as I'm wanting to create my own blog and want to find out where you got this from or exactly what the theme is named. Thank you!